Provider Demographics
NPI:1396384343
Name:KOTLYAR, VERA (RD)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:KOTLYAR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2983 FARMHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-7060
Mailing Address - Country:US
Mailing Address - Phone:347-967-6410
Mailing Address - Fax:
Practice Address - Street 1:2983 FARMHOUSE DR
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-7060
Practice Address - Country:US
Practice Address - Phone:347-967-6410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-21
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005851133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty